Neutrophil-to-Lymphocyte Ratio and Risk of Nodal Metastasis in Early-Stage Lung Adenocarcinoma: A Brief Report From a Multicentric Analysis

• Despite proper staging, up to 20% of the patients with non-small cell lung cancer shows unforeseen nodal metastases at surgery. Neutrophil-to-lymphocyte ratio (NLR) is an accessible biomarker of systemic inflammation and reflects lung adenocarcinoma progression and metastasis. • NLR ≥ 3.5 predicted unforeseen nodal metastases in lung adenocarcinoma in a large population Implementation of NLR in the preoperative evaluation of patients with early-stage adenocarcinoma may identify patients at risk for unforeseen nodal metastases that may benefit from more extensive staging despite clinically negative mediastinal lymph nodes. Systemic inflammation, as outlined by higher NLR values, may participate in early-stage lung adenocarcinoma progression and nodal metastatic spread.